The purposes of this study were to evaluate the frequency of documented prognosis discussions among terminally ill cancer patients, to identify correlates of having documented prognosis discussions, and to describe the content of prognosis discussions as documented in patient medical records. Sample data were collected from the randomly selected medical records of inpatients (n=210) aged 65 years or older and admitted with diagnoses of brain, pancreas, liver, gall bladder, or inoperable lung cancer from six large Connecticut hospitals. A standardized instrument was used to extract data concerning patient demographics, hospital course, prognosis discussions, and evidence of advance care planning. Prognosis discussions were recorded in 79 (38%) of medical records and were correlated with emergency admission status (p=0.004) and longer length of hospital stay (p=0.003) on multivariate analysis. Of the documented prognosis discussions, 63% were within one week of admission but after the first day, and 57% included the patient, 76% included the family, 77 % included the doctor, and 69% did not include another health staff member (n=79). Life sustaining treatment discussions and DNR orders were both associated with prognosis discussions (p=0.001 and p=0.001, respectively) and were more often documented after the prognosis discussions. Prognosis discussions included planning for care and treatment in 33 (42%) of discussions documented. In conclusion, we found that prognosis discussions were infrequently documented during the hospitalization of terminally ill patients diagnosed with cancer. We also found that advance care planning, such as discussions of life sustaining treatment and DNR orders, was significantly associated with prognosis discussions and more often occurred after prognosis was discussed.

Thesis--University of Oregon. / On spine: Older women in a diploma school of nursing. Vita. Includes bibliographical references (leaves 121-127).

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 173-191).

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Centenarian population studies are one of several approaches currently used to study the aging process and characterize successful aging. I have described a methodology permitting the simultaneous generation of RNA, DNA, protein, and plasma samples, as well as fixed peripheral blood mononuclear cells (PBMC) and frozen blood aliquots, from a single 10- to 30-ml sample of peripheral blood obtained from donors of any age, and showed that although extremely old individuals are somewhat anemic, it is possible to obtain enough biological material from their blood to conduct aging studies. / I investigated the possibility of immortalizing B-lymphocytes from extremely old individuals, using the Epstein-Barr virus (EBV), and found that although extremely old individuals (90+ years) possess low levels of circulating B-lymphocytes, it is possible to immortalize B cells present in less than one milliliter of their blood using EBV. / Using biological material obtained from blood samples of individuals of all ages by the method for blood sample processing I have described, I studied the mRNA expression of cell death (specifically caspase) genes in nonagenarians and centenarians, successful models of aging who have survived or avoided age-associated diseases, as well as in their younger counterparts, to determine whether apoptotic genes may be part of the genetic determinants of longevity. I found that a population of extremely old individuals (90+) shows a unique pattern of caspase mRNA expression, characterized by high levels of caspase-1 and -3, and low levels of caspase-8, mRNA, while slightly less aged individuals (70--89) are characterized by high levels of caspase-8 mRNA expression. Furthermore, I showed that these changes in caspase mRNA do not appear to result from age-related changes in PBMC composition, such as decreases in CD24. Therefore, I suggest that unique patterns of caspase mRNA result from the regulation of message abundance on a per cell basis, via a putative regulation of caspase genes at the transcription or RNA processing level, rather than age-associated changes in immune profiles.

The term, spirituality, as used in this study, refers to that part of our lives that has the deepest meaning, that which nurtures each of us and moves us toward wholeness. It is the basis for which we live out our lives, following our own truths with honesty and commitment. Hopefully, in the process of aging we mature spiritually, using experiences collected and processed over a lifetime and learning from them what is most important in leading a fulfilling life. For this study, a group of 10 women aged 60-87 years was examined, using in-depth interviews to determine those aspects of their lives that contributed to their spiritual growth and to see how they found meaning as they matured over their lifetimes. Furthermore, each woman was asked to discuss what gives her life the most meaning and purpose today. The women were selected for their apparent spiritual maturity, as observed by those who know them. The results of the study are organized around themes as they relate to different periods of the life span, starting with childhood and ending in elderhood. Early memories of the women were centered around family and friends, then expanded to include school, career, and in most cases marriage and children. Some have grandchildren. The family of origin was a critical beginning for each woman. Most recalled a happy and loving childhood, and those that did not, seem to have worked through those parts of their childhood relationships and experiences that have troubled them. Over their life spans, the women faced turning points or crises that caused them to grow in new ways, not only to survive, but to find new strength, courage, and meaning. As the women became older adults, their losses became more numerous. They have developed ways to grow spiritually despite these multiple losses and diminishments that continue into the present. Role models have played a meaningful part in each woman's life. Throughout childhood, adulthood, and old age, the women have looked to others who taught them various social and coping skills which contributed to the fullness in their lives. They developed such traits as loving others, caring for those in need, and helping friends and family. The role models fostered independence and development of strengths and guided the women to become who they are today. These women in turn serve as role models for others. The acceptance of death as a part of life lends a peacefulness in old age for the women. Their families and friends continue to play a key role in their everyday lives, along with faith and religious practices, God or a Supreme Being, prayer, meditation, reading, writing, learning new things, helping and listening to others, and service to community. Giving and receiving love is basic in their lives. The women also feel that love and helping others are essential components for a healthy humanity. The women are grateful for life's many gifts. Although old age brings hardships, losses, and diminishments, they find that life has been generous to them, and they continue to have hope for the future. Their spiritual strength continues to grow and expand, accompanied by a new sense of freedom that was not present in their younger years. Contrary to messages received from society, these women have found that there are benefits in growing old. / Graduation date: 1993

Doctor of Philosophy (PhD) / Aged care is a critical public policy issue in Australia. The growing significance of the sector raises important and pressing questions about many aspects of care itself, the size of the labour force and employment relations. Answering these questions is vital, with demand for labour in the sector already outstripping supply and with demand certain to grow substantially. The implications of this labour shortfall for the sector have already been the subject of a number of key government reports. Although these reports have begun to construct a more detailed picture of the issues facing aged care workers and employers, significant gaps remain, most notably any explicit examination of approaches to the management of labour or the importance of labour law in determining these approaches. Despite the obvious importance and critical social and economic significance of the ageing population, we do not sufficiently understand many of the critical labour market features, workplace characteristics or management strategies which are evident in the aged care sector. This study seeks to build knowledge of employment and labour management in this growing and crucial sector at a decisive moment in history. It deepens our understanding of these issues and processes through a study of three residential aged care providers in New South Wales during the period from 2005 to 2009. The thesis specifically examines employer strategy in relation to the management of labour in the three cases. Further, it investigates the impact of the regulatory environment on these approaches. In doing so, the case studies reveal the intricate web of internal and external, direct and indirect, formal and informal regulation which shapes the management of labour within the sector. The complexity of the regulatory web in aged care demands the use of an explanatory framework which recognises that labour-management approaches are influenced by constraints not traditionally associated with the direct, legal regulation of employment relations. Consequently, regulation theory is applied here as an organising framework and as an interpretive prism for the research. This allows for an explicit acknowledgment of the importance of non-legal, informal and indirect regulation ‘at work’ in this sector. The study finds that in the period under review labour law was not the primary determinant of labour-management approaches in aged care. The case studies presented here show that it was, in fact, a second order consideration for aged care providers struggling with what they saw as insufficient funding, onerous ‘paperwork’ and staff recruitment and retention difficulties – in short a range of other regulatory influences. This study also shows that, despite the constraints imposed by these other regulatory modes, employers remained free to exercise their prerogative within the workplace; this, in turn, is revealed as a form of internal regulation in aged care.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.